Evaluating hoarseness: keeping your patient's voice healthy.

Hoarseness is the term often used by patients to describe changes in their voice quality. The causes of hoarseness are determined after obtaining a detailed medical history of the circumstances preceding the onset of hoarseness and performing a thorough physical examination. The latter may include visualization of the vocal cords, possibly using indirect laryngoscopy, flexible nasolaryngoscopy or strobovideolaryngoscopy. In the absence of an upper respiratory tract infection, any patient with hoarseness persisting for more than two weeks requires a complete evaluation. When the patient has a history of tobacco use, cancer of the head and neck must be considered and ruled out. Voice abuse is one of the most common causes of hoarseness and can lead to other vocal pathologies such as vocal nodules. Good vocal hygiene can prevent and treat some pathologies, and voice therapy is a cornerstone of management in some cases of hoarseness.